A high-level visit, a warning on Medicare

Over the next 30 years, the elderly in the United States will increase from 40 million to 70 million. That simple statistic imperils the 35-year-old Medicare system, Health and Human Services Secretary Donna E. Shalala told the audience that packed the medical school’s Fitkin Amphitheater in October. “We are facing a demographic tidal wave,” said Shalala. “We are about to double the number of people in Medicare on a relatively narrow financial base.”

Shalala, to whom Dean David A. Kessler, M.D., reported in his previous position as Food and Drug Administration commissioner, was on campus to deliver the annual Samuel O. Thier, M.D., Lecture. Later in the day she spoke at the Yale Law School on patient records and privacy. In her talk in Fitkin, Shalala outlined what has been done to save Medicare and what remains to be done. So far the government has increased the Medicare trust fund; cracked down on fraud, waste and abuse; and instituted reforms such as competitive bidding and a modern billing system. Strengthening the system, she said, will require still more. She called for a modern benefits package that stresses preventive measures, such as screenings and vaccinations, and includes coverage of medications and a competitive and efficient financial structure. “This is a fundamental debate,” she said, “about whether we will continue to guarantee quality health care for seniors.”